RESEARCH - Frequency of successful intra-articular puncture of finger joints: influence of puncture position and physician experience

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Rheumatology Advance Access originally published online on July 25, 2008

Rheumatology 2008 47(10):1503-1505; doi:10.1093/rheumatology/ken295

Frequency of successful intra-articular puncture of finger joints:

influence of puncture position and physician experience

W. Pichler1, W. Grechenig1, S. Grechenig1, F. Anderhuber2, H. Clement1

and A. M. Weinberg3

1Department of Traumatology, 2Department of Anatomy and 3Department of

Paediatric Surgery, Medical University of Graz, Graz, Austria.

Abstract

Objective. Physicians and specialists routinely perform IA punctures

and injections on patients with joint injuries, chronic arthritis and

arthrosis to release joint effusion or to inject drugs. The purpose of

this study was to investigate the frequencies of intra- and

peri-articular cannula positioning during this procedure.

Methods. A total of 300 cadaveric finger joints were injected with a

methyl blue-containing solution and subsequently dissected to

distinguish intra- from peri-articular injections. To assess the

influence of puncture position on successful injection, half of the

joints were injected dorsally and the other half dorso-radially. To

assess the importance of practical experience for a positive outcome,

half of the injections were performed by an inexperienced resident and

half by a skilled specialist.

Results. The overall frequency of occurrence of peri-articular

injections was much higher than expected (overall: 23%, specialist:

15%, resident: 32%) The failure rate was significantly higher than the

average with the joints of the little finger and the DIP joints of

each phalanx.

Conclusions. Even skilled specialists cannot guarantee to insert the

cannula into the joint in every case. Unintended peri-articular drug

injection moreover may affect the surrounding ligaments or tendons,

leading to serious complications. Correct positioning of the needle in

the joint may be facilitated by fluoroscopy in doubtful cases.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/10/1503?etoc

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